Split of MBS item 45626 for correction of entropion or ectropion due to trachoma or non-trachomatous causes factsheet

Page last updated: 30 October 2019

Factsheet - Entropion Split of MBS Item 45626 (PDF 271 KB)
Factsheet - Entropion Split of MBS Item 45626 (DOC 92 KB)


· From 1 November 2019, MBS item 45626 will be split into two items, 45626 and 45627. The intent of this change is to distinguish whether correction of entropion is due to trachoma infection, or other causes.

· These changes are relevant for plastic and reconstructive surgeons and ophthalmologists.

· What does this mean for providers? MBS item 45626 should be claimed for correction of entropion due to causes other than trachoma. MBS item 45627 should be claimed for correction of entropion due to trachoma.

What are the changes?
From 1 November 2019, there will be a revised structure for items for entropion or ectropion due to trachoma or other causes. The new structure includes:

· 1 new item (item number 45627) for correction of entropion due to trachoma

MBS item 45627
Ectropion or entropion (due to trachoma), correction of (unilateral) (Anaes.)
Fee: $331.25 Benefit: 75% = $248.45 85% = $281.60

· 1 amended item (item number 45626) for correction of entropion due to causes other than trachoma

MBS item 45626
Ectropion or entropion (due to causes other than trachoma), correction of (unilateral) (Anaes.)
Fee: $331.25 Benefit: 75% = $248.45 85% = $281.60
Why are the changes being made?
· In line with the World Health Organization (WHO) requirements on the elimination of trachoma, Australia has agreed to report on a comprehensive set of strategies including demonstrating that Australia’s health system is able to identify and manage cases of trachoma.

· Currently, it is difficult to determine from the available MBS data whether a patient has had entropion correction surgery due to trachoma or other causes.

· To allow more accurate data to be captured on trachoma-related surgery the Medical Services Advisory Committee (MSAC) has recommended splitting MBS item 45626 into two items to make this distinction.

What does this mean for providers?
MBS item 45626 should be claimed for correction of entropion due to causes other than trachoma. From 1 November 2019, for correction of entropion due to trachoma, providers should use new MBS item 45627.

How will these changes affect patients?
Eligible patients can continue to receive Medicare rebates when undergoing treatment of trachoma. There is no change to eligibility to receive this service, nor any changes to the Schedule fee or applicable rebate(s).

Who was consulted on the changes?
In line with the World Health Organization (WHO) requirements on the elimination of trachoma, Australia has agreed to report on a comprehensive set of strategies including demonstrating that Australia’s health system is able to identify and manage cases of trachoma.

The Department of Health developed the proposed change in consultation with the Royal Australian and New Zealand College of Ophthalmologists. The change was endorsed by the Medical Services Advisory Committee.

How will the changes be monitored and reviewed?
The Department of Health regularly reviews the usage of new and amended MBS items in consultation with the profession.

All MBS items may be subject to compliance processes and activities, including random and targeted audits which may require a provider to submit information about the services claimed.

Significant variation from forecasted expenditure may warrant review and amendment of fees, and incorrect use of MBS items can result in penalties including the health professional being asked to repay monies that have been incorrectly received.

Where can I find more information?
The full item descriptor(s) and information on other changes to the MBS can be found on the MBS Online website at www.mbsonline.gov.au. You can also subscribe to future MBS updates by visiting MBS Online and clicking ‘Subscribe’.

The Department of Health provides an email advice service for providers seeking advice on interpretation of the MBS items and rules and the Health Insurance Act and associated regulations. If you have a query relating exclusively to interpretation of the Schedule, you should email askMBS@health.gov.au.

Subscribe to ‘News for Health Professionals’ on the Department of Human Services website and you will receive regular news highlights.

If you are seeking advice in relation to Medicare billing, claiming, payments, or obtaining a provider number, please go to the Health Professionals page on the Department of Human Services website or contact the Department of Human Services on the Provider Enquiry Line – 13 21 50.

The data file for software vendors is expected to become available on [date] and can be accessed via the MBS Online website under the Downloads page.

      Please note that the information provided is a general guide only. It is ultimately the responsibility of treating practitioners to use their professional judgment to determine the most clinically appropriate services to provide, and then to ensure that any services billed to Medicare fully meet the eligibility requirements outlined in the legislation.

      This sheet is current as of the Last updated date shown above, and does not account for MBS changes since that date.


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